MEDICARE: MRS. SHAHLA NADIR-MOHAMMADI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	44744	CA

General Provider Information

NPI Number	:	1063549483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAHLA NADIR-MOHAMMADI DDS

Provider Business Mailing Address
First Line	:	20429 YORBA LINDA BLVD
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-3042
Country	:	US
Telephone Number	:	714-695-9530
Fax Number	:	714-695-9521

Provider Business Practice Location Address
First Line	:	20429 YORBA LINDA BLVD
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-3042
Country	:	US
Telephone Number	:	714-695-9530
Fax Number	:	714-695-9521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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